Given the high patient surgical risks inherent to his comorbidities, combined intrapleural therapy (CIT) was started using a protocol similar to that explained by Rahman et al., 4 with 5 mg dornase alfa (DNase) diluted in 45 ml NaCl 0.9% and 10 mg alteplase (fibrinolytic), diluted in 40 ml NaCl 0.9% (both administered sequentially twice a day, for 3 consecutive days), clamping the drain for 1 h following administration of each drug, allowing them to act. Despite antibiotics and the insertion of a new chest tube ( Figure 1A), the patient continued to present with fever, and pleural fluid drainage was very limited during subsequent days. Approximately 24 h after chest tube removal, systemic inflammation was documented, and the chest radiograph showed a left pleural effusion, which thoracic ultrasound proved to be multiloculated (pleural fluid characteristics after thoracentesis were indicative of pleural infection). The procedure was complicated by a left pneumothorax, and a chest tube was placed. Case 1Ī 54-year-old man with a history of cervical spinal cord injury 28 years ago, with tetraparesis and chronic hypercapnic respiratory failure under nocturnal non-invasive ventilation (NIV), was hospitalized for sympathectomy due hyperhidrosis. 4 The authors report two cases of patients with pleural infection who received this treatment, with excellent results. Recent data indicate the effectiveness of intrapleural combined therapy, in which deoxyribonuclease is used in conjunction with a fibrinolytic. Surgery is often required in cases that are not resolved by medical therapy and the risks and costs are not negligible. 1, 2, 3 It can also occur as a complication of pleural management (e.g., surgical procedures) or spontaneously. Pleural infection often complicates pneumonia, with a mortality rate of approximately 20%.
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